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Tuesday, 13 April 2010

A change of paradigm - Don't fear running!

First an update: Now that I have included the blogosphere in the timing of my menstrual cycles, I feel compelled to share the fact that I DID get my period last night. Now that I have officially gotten two periods in 3 months, I am more "regular" than I have ever been i my life. You can add me to the category of "runs > than 60 miles/week, below normal BMI and regular periods", well, relatively. And my BMI is right on the cusp of normal.

And now my brief editorial on running and women's reproductive health:

A lot of medical decisions are based on fear. Doctors fear giving the wrong advice. Women fear doing the wrong thing. (I am, of course, referring mostly to women who are trying to conceive and women who are pregnant.) But when was it established that the "safe" thing to do is be sedentary and the "risky" thing to do is exercise? Of course, the exact opposite is true. All women should have regular exercise at every point in their life. If women can't get pregnant, it is not due to the fact that they are running or exercising. If women have complications in their pregnancy, it is not due to the fact that they are running or exercising. And I am not just talking 30 minutes a day 3 days a week. I am talking 60 minutes a day, every day of the week or more. It is the sedentary lifestyle and western diet that leads to health problems and pregnancy complications.

If a woman can't get pregnant, every health problem should be considered and excluded, including stress and nutritional deficiency, but exercise in itself should NOT be discouraged (Brooke, you also gave us a great example of this). Women SHOULD know the risks of NOT exercising, both when they are pregnant and when they are not.

How much is too much? Well, CBurns and I both experienced that we got pregnant when there was in increase in the intensity of our training. I challenge anyone to find a study that shows a direct association between exercise intensity and decreased likelihood of becoming pregnant.

And what about pregnant women? Some of you have asked about those guidelines. Personally, I did not feel the need to read books or follow guidelines when it came to exercising in pregnancy. If I felt like I was getting nauseated or tired or had Braxton Hicks contractions, I of course, slowed down. I avoided ball sports, because who wants a ball whipped at their uterus while pregnant? But don't FEAR exercise! Fear the sedentary life!

Partly because of this blog and the way people attacked the fact that I ran so much while pregnant, I have read many, many, many studies showing how safe and healthy exercise is in pregnancy. And I didn't even need convincing in the first place. There has been ONE study which showed that "high impact sports" can slightly increase the risk of miscarriage in the first trimester. This included ball sports, horseback riding and running. But no one looked at running separately. I have many other critiques of this study. But compare this to the myriad studies which showed benefits of regular cardiovascular exercise and it is no wonder that my recommendations are in line with those of the Danish Ministry of Health.

Oh, boy, I had better get back to work. But challenge me, readers! I love it when you do! Tell me WHY running 80 miles per week while pregnant or otherwise is UNhealthy! Tell me WHY getting your heart rate up is unhealthy!

11 comments:

I don't know that anyone really says running during pregnancy is bad these days (except maybe old people?).

To be fair, you weren't just "running during pregnancy." You were compulsively working out for 3+ hours each day in obsessive fear of gaining more weight than you thought you could lose in the hospital. People weren't critical (on your blog) of the mere fact that you were running during pregnancy. So to change the question, is it unhealthy to comulsively exercise for many hours a day while pregnant? My answer is: maybe, maybe not but why risk it? It's only 9 months in a whole lifetime. It's not *unhealthy* to exercise moderately during pregnancy, so why test the limits?

Well, I wrote this in response to peoples' concerns. I am not trying to glorify myself. The Girlfriend's Guide to Pregnancy states excercising is too risky during pregnancy to even consider. And that's not written or read by old people (well, maybe some old people read it). I received personally threatening messages by people because they believed that I would miscarry (running coach, among others) due to my running and you can feel free to go back and read what people wrote about it on runandgo. One gal said I would give birth to a baby with muscular dystrophy because I ran so much. I just don't want there to be misconceptions anymore about running in pregnancy or excercise in genernal. And it is GREAT if there aren't!!

You would know better than I do if people still proscribe running during pregnancy. I wonder if that was ever based on actual science? Or just lore?

Some people are just assholes. Some people act out of concern, even if it's misplaced. The unfortunate thing about all things pregnancy and child-related (it seems to me) is that everyone has an opinion and thinks they're right and must spread the good word. I get the impression it never ends. (You let Billy eat that? You let your child do that?. . .You don't have Billy signed up for Ballet???)

Some things are pretty well known, like getting wasted during pregnancy is risky. But with things that appear to have little to no scientific or logical backing, people should probably stand down.

I am from a family of physicians who might be a little old fashioned, but both stressed regular exercise and plenty of low impact exercise in the third trimester.

There was plenty of swimming, though we are probably biased since we all grew up as swimmers. My mom's water actually broke while swimming laps, which may be a reason pregnant women should not swim...thank god for chlorine!

But what slightly worried me about this was that you were so concerned about your weight and calorie intake - obsessed with such a low weight gain when you are so thin! I don't feel anyone should be guilty about taking in large portions of healthy food when they are hungry and pregnant.

I have an 87 lb, 5'3 (Filipino) aunt who gave birth to a 10 lb baby (her other three babies were between 6-7 lbs). She probably got close to 120 when she had that little guy, and not much less with her other three. She eats like crazy all the time anyway, but during pregnancy she eats healthier and exercises, which makes her hungry more often and builds muscle, etc. Some weight gain might be the medications she has to stop during pregnancy which seem to boost an already stellar metabolism.

So yeah, she gained an incredible 40 lbs during each of her pregnancies. She lost it fast and never really worried about it. And 4 kids and almost 20 years later she is now...91 lbs.

87 lbs and 5'3 for some people screams anorexia, yet she was always perfectly healthy (if not a little out of shape, tough to tell when someone has severe asthma). she had 4 babies at that weight. If she worried about BMIs who knows where she'd be. but the same could be true for other women on the opposite end of the scale.

Ideally you'd be focused less on your weight and more on how you feel during, before, after your workouts, and what you are eating. I understand the healthy reasons for your focus, but I think, as happens to the best of us, some of it was just vanity.

While I didn't run during pregnancies, I excercised with both, probably more than "old generation" would have approved (my mom didn't), but less than you did. I am going to say: do as you feel. Back off if it's too much, be reasonable, listen to your body and the baby, and don't get concerned with weight gain but more with staying healthy and toned. I gained over 40 lbs with my second one, and it was tough to loose - no question. I ate like a machine, allowing myself just this one time in my life, this only time, to NOT feel guilty. It felt great to forgo my usual obsession with the way I look. I don't regret it one bit. Would I have like to run if I knew about running back then (yes, I wasn't into running yet)? Yes. But just because I think it's cute to do, as well as run with a baby jogger. I backpacked with 50lbs pack and a 5 yo on my shoulders in the mountains though - you should have seen the look there! At 6 months pregnant. I gave birth to a 9.5 lbs baby.Anyhow, I think I'll echo Danni with the fact that your blog attracted negative comments not due to excercising as is, but because you put yourself into forced "I am not like you and I don't care" position. I do that a lot too, and I know now how to catch myself:) And at least in your posts there was way too much emphasis on "low BMI is awesome for future mom, and don't tell me otherwise". When in real life, it probably would have attracted fewer angry folks if you'd said "I love to run, I love to bike and swim, I feel great and I'll keep doing it for now, and if my weight stays low, that would be a benefit, but if not, I won't die of it".Many, oh, so many female are obsessed with weight. I am, I was, and I probably will be. But the degree of it is different. I know passing 40'th birthday really opened my eyes on many things. I still prefer to look good, and I will make an effort to never be overweight. But I focus on health more then the number.Funny, Larry said when we met I didn't plan to live past 60. I didn't. Now I feel my life is just beginning, and I want to ensure I am capable and able to enjoy it:)

I suppose you would have to define what you mean by unhealthy and to whom it refers. Is it unhealthy for you or is it unhealthy for the fetus? Is it unhealthy for your physical body or unhealthy for your mental health? Those would be questions an individual would have to answer herself. Also, I kind of wonder why people care so much whether a woman exercises during her pregnancy. Then again, strangers seem to have an awful lot to say to a pregnant woman about what she choose to do with her own body.

Just my experience...I got pregnant fairly easily running about 60 miles a week, but I always had regular cycles. Of note..I am also "advanced maternal age", getting pregnant at 36. At my doc's urging, I cut my mileage down to 40 a week, but it was a constant battle throughout my pregnancy of her wanting me to do less exercise, and me having to make promises to do less and less. I ran until 35 weeks, when I strained my lower back and couldn't even go walking, but then I rode the bike trainer. I gained 16 pounds, and had a healthy 5 lb, 15 oz baby, so he was little, but I am 4'11" and started out weighing 100 pounds.

In hindsight, I think I would have been just fine doing what my body told me, and not following a forced schedule of mileage reduction. I slowed down dramatically without trying, so I think that was my body's way of taking it easier. I think most physicians just can't take the risk of telling patients it's ok to run high miles though...it's just unfamiliar territory for most.

Well, I think the way physicians view this topic is slowly changing. And it is no surprise that most of the readers of this blog are on the same page. I really thank all of you for sharing your experiences. (And I thank Danni for the haiku she left on my facebook page :)). But Clea, you bring up a really interesting example of a physician thinking runnning is okay, but being uncertain. And I think this is what a lot of women face. And I guess the more positive experiences women have, the less fear there will be involved.

When I was TTC and starting seeing a specialist after about a year the first thing he said to me was stop running and gain weight! I had a low normal BMI and was actually at my heaviest in years due to hypothyroid. Luckily for him and maybe me I had a stress fx and needed to take time off marathon training. The following month I was pregnant, coincidence? I'm not sure and it probably won't make me quit running next time we're TTC, but it does make me wonder. He did say keep working out and was ok with me running a marathon early in my pregnancy, but did I get some comments from others when they found out I ran a marathon pregnant!

I think Dr.'s, especially OBGYN, practice defensive medicine. If they don't tell you anything is safe, you can't sue them. Which is a shame.With that being said,I was encouraged to exercise through pregnancy and when I miscarried at 15 weeks all of the MD's, CNM's, & RN's I saw said that exercise had nothing to do with it. From personal experience, when the unfortunate does happen, logically you know that it wasn't anything you did or didn't do but the other part of you needs something tangible to blame it on. It's really hard to not feel as if you have some sort of control over the situation (at least for me). That you miscarried because of dumb luck. I think exercise gets maligned in that respect. It's tangible and you don't have to do it in order to have a successful pregnancy.

Marathon Princess,That is interesting. I guess all I can say is it is really hard to say why you got pregnant when you did. But if decreased training did lower your stress level, then maybe it WAS that. Did you gain weight at the same time? Well, next time you TTC, you can do the experiment yourself and see if you get pregnant while training hard. That is also the experiment I am engaging in right now, I guess.

Kathleen, I am really sorry to hear about your experience. I can't imagine the sadness. And definitely also the need to blame it on something. I give the doctors and nurses a lot of credit for not laying blame on any one thing, because it is EXTREMELY rare one can know exactly what the cause was. But it is these stories and other anecdotal evidence that scare people and doctors' advice and womens' decisions should be based instead on the individual's comfort level with exercise and large studies of the effects of excercise on pregnancy.

Hello from Rude Skov

Photo by Stine Sophie Winckel

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My name is Tracy. I am a physician scientist from the USA, living with my husband and two young boys in Denmark. I work as a post-doc fellow at Næstved Hospital. I have a scientific interest in vision loss, vision loss during exercise, exercise, running during pregnancy, MAF training as well as nutrition and health for athletes. I also have a love for music, physics, statistics, cycling, yoga, cross-country skiing, bla bla bal.

I was a member of Team USA at the IAU World Championships in Ultra Trail Running in 2013 in Wales. I am now training to run with Team Denmark at the IAU World Championships in Annency, France in May 2015.